In the healthcare setting, how does patient-centered care affect patient satisfaction and patient outcomes for patients receiving care?

3262  |  wileyonlinelibrary.com/journal/jocn J Clin Nurs. 2019;28:3262–3270.© 2019 John Wiley & Sons Ltd

Received: 9 November 2018  |  Revised: 18 April 2019  |  Accepted: 2 May 2019

DOI: 10.1111/jocn.14903

O R I G I N A L A R T I C L E

Improved patient satisfaction 2 years after introducing person‐ centred handover in an oncological inpatient care setting

Anna Kullberg RN, PhD, Nursing Development Manager1  | Lena Sharp RN, PhD, Head of Department2,3 | Hemming Johansson MSc, Statistician1 | Yvonne Brandberg PhD, Psychologist1 | Mia Bergenmar RN, PhD, Assistant Professor1,4

1Department of Oncology‐Pathology, Karolinska Institutet, Stockholm, Sweden 2Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden 3Regional Cancer Centre Stockholm‐ Gotland, Stockholm, Sweden 4Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden

Correspondence Anna Kullberg, Department of Oncology‐ Pathology, Karolinska Institutet, Stockholm 171 76, Sweden. Email: [email protected]

Abstract Aims and objectives: To investigate patients’ satisfaction with care, 2 years after the introduction of person‐centred handover (PCH) in an oncological inpatient setting, and to describe patients’ perceptions of individualised care. Background: To obtain higher levels of patient satisfaction, bedside nursing hando‐ vers have been evaluated with positive results. One such model is PCH, which blends aspects of person‐centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together. Design: A survey‐based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards. Method: Patient satisfaction was measured with the EORTC IN‐PATSAT32 question‐ naire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017– March 2018. Of these, 90 chose to participate. The STROBE checklist for cross‐sec‐ tional studies was used when preparing the paper. Results: Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales “Exchange of information be‐ tween caregivers” and “Nurses’ information provision” postimplementation of PCH. Regarding patients’ perceptions of individualised care, the highest scores were in the ICS‐A subscale “Clinical situation” and ICS‐B “Decisional control,” while “Personal life situation” scored the lowest overall. Conclusions: Person‐centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses’ information provision, indicating that PCH can facilitate effective information exchange between patients and nurses. Relevance to clinical practice: Person‐centred handover seems to improve patients’ satisfaction with nurses’ provision and exchange of information. Nurses and manag‐ ers should carefully consider the implementation process of PCH and evaluate its long‐term effects. PCH can be recommended in the oncology inpatient setting.

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1  | INTRODUC TION

The importance of transforming health care to further promote patients’ influence and participation has been widely described, both in terms of health outcomes such as patient safety and treat‐ ment adherence (Davis, Jacklin, Sevdalis, & Vincent, 2007; Longtin et al., 2010) and in terms of the ethical aspect of patients’ right to information (Lee & Garvin, 2003) and to shared decision‐making (Ekman et al., 2011). In this context, lawmakers have placed legal demands on healthcare providers to enhance patient participation (SFS, 2015). New models of care are being developed to promote patient satisfaction and enhance patients’ experiences of partici‐ pation. One example is person‐centred care, which is an approach where each person's care is planned in a joint partnership between the healthcare professionals, the patient and the patient's close ones (Ekman et al., 2011). Person‐centred care lacks a universal, es‐ tablished and widely accepted definition. There are, however, core concepts, such as promoting participation, shared decision‐making in care and personalised information exchange, utilising the per‐ son's own capacities and resources, while recognising each person's unique needs, values, wishes and expectations in relation to illness and health (Alharbi, Carlstrom, Ekman, Jarneborn, & Olsson, 2014; Dewing & McCormack, 2016; Lor, Crooks, & Tluczek, 2016; Morgan & Yoder, 2012; Sharma, Bamford, & Dodman, 2016). In a review, the individualisation of care is described as a central component of person‐centredness (de Silva, 2014). The two concepts are thus in‐ tertwined. Individualised care is often described as being tailored to each patient's demands and needs, while allowing for variations in the delivery of health care (Charalambous, Chappell, Katajisto, & Suhonen, 2012; Suhonen, Valimaki, Leino‐Kilpi, & Katajisto, 2004). Measures of patient satisfaction and patients’ perceptions of in‐ dividualised care have been used as experience outcomes when evaluating person‐centred nursing interventions (Morgan & Yoder, 2012). Associations between patient satisfaction and individualised care have also been demonstrated, and individualised care has been shown to predict patient satisfaction (Suhonen, Papastavrou, et al., 2012).

2  | BACKGROUND

To promote, implement and maintain person‐centredness in health care, it is necessary to incorporate its ethics and approaches into the practicalities of care (Britten et al., 2017). The nurse shift‐to‐shift handover in inpatient settings has been identified as a core nursing task and an activity where patient participation could possibly be enhanced. Traditionally, nurse‐to‐nurse reports are oral or recorded

and carried out behind closed doors at the nurses’ station. This pro‐ cedure excludes the patients. Nurse handovers have been described as a critical procedure, with a high risk of miscommunication, which can result in missed care, medical errors and declining patient par‐ ticipation (Staggers & Blaz, 2013; Staggers, Clark, Blaz, & Kapsandoy, 2011; Thomson, Tourangeau, Jeffs, & Puts, 2017). Effective com‐ munication between healthcare professionals and patients and/or the patient's close ones is a prerequisite for improving patient sat‐ isfaction and safety (Bredart et al., 2007; Lee & Garvin, 2003; Wolf, Lehman, Quinlin, Zullo, & Hoffman, 2008). The handover provides an opportunity for information exchange.

The development of bedside nursing handover models has been ongoing in various inpatient settings for decades. Quantitative evaluations have shown mainly positive results in outcomes, such as patients’ satisfaction with care (Ford, Heyman, & Chapman, 2014; Radtke, 2013; Sand‐Jecklin & Sherman, 2014; Scheidenhelm & Reitz, 2017), nurses’ satisfaction with care (Johnson, Sanchez, & Zheng, 2016) and patient safety (Groves, Manges, & Scott‐ Cawiezell, 2016; Kerr, Klim, Kelly, & McCann, 2016; Kerr, Lu, & McKinlay, 2013). Several studies have also described patients’ experiences of performing and participating in handovers at the bedside. For example, patients have reported that bedside hando‐ vers created an opportunity for increased participation (Lupieri, Creatti, & Palese, 2016), and that they felt safer and reassured that they were being taken care of (Cahill, 1998). In addition, bedside handovers have been shown to promote shared decision‐making (McMurray, Chaboyer, Wallis, Johnson, & Gehrke, 2011). Some of these results from the qualitative evaluations of bedside hando‐ vers reflect concepts found in descriptions of individualised care (Charalambous et al., 2012). Following these positive results and the lack of larger studies with comparative data (Smeulers, Lucas, & Vermeulen, 2014), recent and more ambitious studies have been initiated to build more rigorous evidence concerning the effects of

K E Y W O R D S

bedside handover, communication, handover, individualised care, information exchange, nursing, oncology, patient satisfaction, person‐centred care

What does this paper contribute to the wider global clinical community? • This paper presents novel findings on the long‐term ef‐

fects of a bedside shift handover model in the oncology inpatient setting, which has not previously been studied.

• Person‐centred handovers improve patients satisfaction with information exchange and information provision by nurses.

• Person‐centred handovers can be recommended for practice in the inpatient oncology setting

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bedside handovers. One example is the use of a multicentre, longi‐ tudinal mixed methods design (Malfait, Eeckloo, Lust, VanBiesen, & VanHecke, 2016). At the same time, difficulties regarding im‐ plementation and nurse adherence to the new model have been described (Malfait et al., 2018).

One such model is person‐centred handover (PCH) that has the aim of blending bedside nurse handover with the approach and eth‐ ics of person‐centred care. PCH is the shift‐to‐shift report between nursing staff and the patient. Conducted at bedside, or wherever the patient prefers, PCH allows for information exchange between the morning shift, the patient and the evening shift. It also includes a safety check where, for example, fall risk, current medications and ID are checked and discussed with the patient. The patients are en‐ couraged to share their experiences related to their daily care, to ask questions and to speak up. The handover is performed based on a structure with a focus on patient participation and the sharing of rel‐ evant clinical information, including patient safety (Kullberg, Sharp, Johansson, Brandberg, & Bergenmar, 2017).

In 2015, PCH was introduced and has since been maintained as standard care in the inpatient wards at the Department of Oncology, Karolinska University Hospital. PCH was evaluated shortly after being introduced by comparing it to routine handover with regard to patient satisfaction as perceived by patients (Kullberg et al., 2017). In the analysis, only one subscale (exchange of information between caregivers) showed a statistically significant difference between the intervention ward and the control wards. The results might have been affected by the premature timing of the evaluation, which began too soon, approximately one month after initiating the imple‐ mentation of person‐centred handover. In addition, the department underwent major changes in leadership and financial cuts during the evaluation period.

More recently, a qualitative study was performed in the depart‐ ment, which investigated nurses’ perceptions of working with PCH (Kullberg, Sharp, Dahl, Brandberg, & Bergenmar, 2018). The results indicated that PCH was an established routine in the wards. We therefore decided to evaluate PCH from a longer‐term perspective.

2.1 | Aims

The primary aim was to assess patients’ satisfaction with care two years after the introduction of person‐centred handovers in the on‐ cological inpatient setting and to compare the results to baseline measurements. The secondary aim was to describe patients’ percep‐ tions of individualised care.

3  | METHODS

In this study, data on patient satisfaction and individualised care were collected from August 2017–March 2018. Data on patient satisfaction from a previous study (Kullberg et al., 2017) were used for comparison. This study thus employed an independent group design in which patients could respond only once. The research is

presented according to the STROBE checklist for cross‐sectional studies, see File S1.

3.1 | Setting

The study was conducted in the inpatient wards of the Department of Oncology, Karolinska University Hospital. The two wards pro‐ vided acute care for adult patients with solid tumours. The wards had different specialisations: one primarily cared for patients with gynaecological malignancies or breast cancer, and the other was pri‐ marily for patients with gastrointestinal, urological, head and neck or lung cancer. The patients were either in a curative or palliative phase and underwent radio‐, targeted‐ and/or chemotherapy. Admissions were either acute or planned. The 18‐bed wards had the same staff ratio, the same median length of stay (approximately five days) and a similar nursing workload. PCH had been an established routine on both wards for the previous two years. An extensive description of the PCH model can be found in our previous paper (Kullberg et al., 2017).

3.2 | Study sample calculation

In the large international cross‐cultural study in which the psycho‐ metric characteristics of the questionnaire EORTC IN‐PATSAT32 were assessed, the mean value and standard deviation (SD) for “ex‐ change of information between caregivers” was 65 (25) of 100, re‐ spectively (Bredart et al., 2005). For data from a previous evaluation study in the oncology department, the mean value (SD) of “exchange of information between caregivers” was 63 (25) among 104 patients (Kullberg, Sharp, Johansson, & Bergenmar, 2015). A sample of 100 patients in the present study would result in a power (1‐β) of 80% to detect a true mean difference of 10 units between patient data from the previous measurements and those from the present study, using a significance level (α) of 5%. Accordingly, the target in the present study was to include a total of 100 patients.

3.3 | Patients

Patients with cancer ≥18 years old, who had been hospitalised for at least three days and understood and spoke Swedish, were invited to participate. Cognitively impaired patients and patients with a se‐ verely reduced general condition were excluded. Each patient could only participate once.

3.4 | Data collection

One of the authors (AK) screened the electronic health records (EHRs) on weekdays to identify patients who fulfilled the inclu‐ sion criteria. Additional information regarding the patient's cur‐ rent status was obtained from the responsible nurse on the ward. Patients who fulfilled the inclusion criteria received written and oral information about the study by AK while they were in‐house. Patients who were interested in participating in the study received

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the questionnaires and were invited to respond either during their hospital stay or after discharge and were instructed to return the questionnaires in a prepaid envelope by regular mail to the project leader (MB). A completed questionnaire was regarded as informed consent for participation.

Data on sex, age and treatment intention were gathered from the EHRs of all eligible patients who chose to participate.

The data on patient satisfaction from a previous study, which was used for comparison (T1), were collected from the same wards prior to the introduction of PCH (Kullberg et al., 2017). In the previ‐ ous study, the same two wards involved in the present study served as a comparison group. By that time, in 2015, the wards employed a nonoral handover model based on the patients’ EHRs, without any nurse–patient interactions.

3.5 | Questionnaires

3.5.1 | Patient satisfaction

The primary outcome was patients’ perception of the staffs’ ex‐ change of information. The EORTC INPATSAT‐32, in which the ex‐ change of information comprises one subscale, was used to collect data on patient satisfaction. In all, the questionnaire covered the subscales of doctors’ and nurses' technical skills (DTS: 3 items and NTS: 3 items), interpersonal skills (DIS: 3 items and NIS: 3 items), information provision (DIP: 3 items and NIP: 3 items) and availability (DAV: 2 items and NAV: 2 items); other hospital staff's interpersonal skills and information provision (OTH: 3 items), exchange of infor‐ mation (EXE: 1 item) and waiting time (WAI: 2 items); and hospital accessibility (ACC: 2 items), comfort and cleanliness (COM: 1 item) and general satisfaction (GEN: 1 item). The EORTC IN‐PATSAT32 was specifically developed for hospitalised patients with cancer. The Swedish version of the test has demonstrated excellent internal consistency, convergent validity and high reliability (Bredart et al., 2005). This instrument has been used in the previous evaluations of the project, thus allowing for comparisons.

3.5.2 | Individualised care

To measure the extent to which patients perceive their nursing care as tailored and individualised to their own needs and preferences, the Individualized Care Scale (ICS) was used as a secondary out‐ come measure. Developed by Suhonen, Leino‐Kilpi, and Valimaki, (2005), the ICS is a two‐part instrument (ICS‐A/ICS‐B) comprised of 17 items each, which are to be answered using a 5‐point Likert scale ranging from 1 = “strongly disagree” to 5 = “strongly agree.” The ICS‐A measures patients’ rating of how nursing care supports individuality, and the ICS‐B assesses how individuality is perceived in the care received. Both ICS‐A and ICS‐B cover the three subscales “Clinical situation” (7 items), “Personal life situation” (4 items) and “Decisional control over care” (6 items; Suhonen, Schmidt, & Radwin, 2007). The ICS is one of the four most used instruments to measure person‐centred care (de Silva, 2014), has proven construct criterion

and cross‐cultural validity (Suhonen et al., 2010, 2016) and has been used in the inpatient cancer setting (Charalambous et al., 2016).

3.6 | Data analysis

Response scores for the primary outcome (EORTC INPATSAT‐32) were linearly transformed to a 0–100 scale, according to the EORTC recommendation, where higher scores represent higher satisfaction (Bredart et al., 2005). Mean scores for each scale of the EORTC IN‐ PATSAT32 were calculated. These scores were imported into a lin‐ ear regression model with the corresponding data from the previous study. Exposure to PCH was the independent variable, and patient satisfaction scores were the dependent variable. The Wald test, em‐ bedded in the regression models, was used to test the comparisons for statistical significance. First, in the univariate regression model, only the exposure to the PCH variable and the patient satisfaction scores were included. Second, in a multivariate regression model, the background variables such as age (continuous), sex (female/male) and treatment intention (palliative/curative) were included as covari‐ ates. The results are presented as the mean differences between the groups for the uni‐ and multivariate analyses, respectively, together with their 95% confidence intervals.

In the ICS, sum scores for the ICS‐A and ICS‐B were calculated as the mean values for the two parts and for their three respective sub‐ scales for each patient. The responses were summarised and divided by the number of items in each scale, generating a value between 1–5 per part and subscale. Higher values indicated more individual‐ ised care. Since the ICS has not been used in previous evaluations of person‐centred handovers, a comparison was not possible.

3.7 | Ethical considerations

The study was approved by the Regional Ethical Review Board, Stockholm (2017/750‐31/2). To avoid social desirability and promote voluntariness, a researcher (AK) not employed at any of the wards, informed the patients and asked for their consent to participate. Since most patients who took part in the study were severely ill, it was vital to optimise the enrolment process. Thus, implicit informed consent was employed, which meant that a returned questionnaire was regarded as consent to participate in the study. If the patients did not wish to participate, they could simply refrain from filling out the questionnaires, and no reminders were sent to nonresponders in an effort to decrease the patients’ burden.

4  | RESULTS

Of 120 patients fulfilling the inclusion criteria during the study period, 90 chose to participate in the study, yielding an overall re‐ sponse rate of 75%. Of the responding patients, 58% (n = 53) were female, and the mean age was 64 years in the total sample, ranging from 18–83 years. The patients in the previous study used for com‐ parison were similar in terms of age and sex. There was, however, a

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larger proportion (81%) of patients in a palliative stage in the present data collection compared with the previous evaluation (68%).

4.1 | Patient satisfaction

The main outcome in the present study (T2) was the mean score of the subscale “Exchange of information between caregivers” (EXE), in comparison with the previous measurement (T1). There was a statistically significant (p < 0.001) improvement of 15 units at T2 compared with T1, both in the univariate analysis and the multivari‐ ate analysis, controlling for age, sex and treatment intention. There was also a statistically significant improvement (p = 0.028) on the subscale “Nurses’ information provision” (NIP) at T2, 2 years after the introduction of PCH. The results from the measurement of IN‐PATSAT32 are shown in Table 1. Regarding the doctors’ scales, “Doctors’ interpersonal skills” (DIS) and “Doctors’ availability” (DAV), the participants scored significantly lower at T2 compared with T1 (p < 0.001 and p = 0.002, respectively). The subscale “Comfort and cleanliness” (COM) presented a 15 unit lower score at T2 (p < 0.001). The statistically significant findings in the univariate analyses were all sustained when controlled for age, sex and treatment intentions.

4.2 | Individualised care

The scores from the Individualized Care Scale are presented in Table 2, together with response rates for the subscales. The subscale “Personal life situation” received the lowest scores for both part A, where the patients rated how individuality was supported, and part B, where the patients rated their perceptions of individuality of care. Overall, higher scores were found in part B than in part A.

5  | DISCUSSION

In this study, patient satisfaction and individualised care were inves‐ tigated two years after the introduction of PCH. The mean score of the IN‐PATSAT32 subscales “Exchange of information between car‐ egivers” and “Nurses’ information provision” was significantly higher than the previous measurement from the same wards. Regarding individualised care, patients’ rating of how nursing care supported individuality was lower than how individuality was perceived in the care received. This study provides a description of long‐term out‐ comes after introducing PCH in an acute oncology setting.

TA B L E 1   Mean scores of the EORTC IN‐PATSAT32 scales at the different points of measurement (T1 is a compilation of data from the previous measurement, and T2 represents the data collected in the current study) represent the comparison with uni‐ and multivariate regression analyses. The level of significance was 0.05

EORTC IN‐PATSAT32 scale

Mean (Standard deviation) Univariate Multivariatea

T1 (n = 103) T2 (n = 90) Mean difference (95% CI) pb

Mean difference (95% CI) pb

Doctors’ interpersonal skills (DIS)

75 (24) 60 (30) −15 (−22 to −7) <0.001 −14 (−23 to −7) <0.001

Doctors’ technical skills (DTS) 74 (23) 71 (23) −3 (−9 to 4) 0.394 −3 (−10 to 4) 0.405

Doctors’ information provision (DIP)

69 (27) 68 (25) −3 (−10 to 4) 0.871 0 (−8 to 7) 0.948

Doctors’ availability (DAV) 68 (25) 55 (28) −13 (−20 to −5) 0.001 −13 (−20 to −5) 0.002

Nurses’ interpersonal skills (NIS)

83 (20) 83 (23) 0 (−6 to 6) 0.964 0 (−6 to 6) 0.946

Nurses’ technical skills (NTS) 82 (21) 79 (20) −3 (−8 to 3) 0.364 −2 (−8 to 3) 0.409

Nurses’ information provision (NIP)

74 (23) 81 (22) 7 (1 to 14) 0.028 8 (1 to 14) 0.025

Nurses’ availability (NAV) 78 (21) 72 (25) −6 (−12 to 1) 0.086 −6 (−13 to 1) 0.088

Other hospital personnel inter‐ personal skills and informa‐ tion provision (OTH)

71 (20) 72 (24) 1 (−6 to 7) 0.814 1 (−6 to 7) 0.814

Waiting time (WAI) 67 (25) 63 (23) −4 (−11 to 3) 0.282 −3 (−10 to 4) 0.392

Access (ACC) 48 (27) 49 (27) 1 (−7 to 8) 0.865 1 (−7 to 9) 0.750

Exchange of information (EXE) 62 (26) 77 (26) 15 (7 to 22) <0.001 15 (7 to 23) <0.001

Comfort and cleanliness (COM)

51 (31) 37 (31) −15 (−24 to 6) 0.001 −14 (−23 to 5) 0.003

General satisfaction (GEN) 80 (21) 80 (22) 0 (−6 to 6) 0.958 −1 (−6 to 7) 0.829

aControlling for age, sex and treatment intention. bWald test.

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The most striking and relevant result in this study was related to our primary outcome, “Exchange of information between caregiv‐ ers” (EXE). The hypothesis was that, through the introduction and maintenance of PCH, the patients’ perceptions of information ex‐ change would improve, and possibly patients’ perceptions of nurses’ information provision as well. In a previous study from the same de‐ partment, patients who were exposed to PCH scored significantly higher (mean score = 73, compared to 62 in the control wards) on this scale (Kullberg et al., 2017). In the present study, 2 years later, patients exposed to PCH scored even higher. Because no other stud‐ ies using the EORTC IN‐PATSAT32 to evaluate PCH or other bed‐ side handover models could be identified, a direct comparison of our findings is difficult. Patient satisfaction has, however, been used as an outcome measure in other patient groups. In an American medi‐ cal‐surgical setting, bedside handovers were evaluated using a quasi‐ experimental design including a 13‐month follow‐up (Sand‐Jecklin & Sherman, 2014). Among other results, improvement regarding the question “Communicated important information shift to shift” was found compared to baseline measurements. This particular ques‐ tion resembles the EXE scale of the IN‐PATSAT32. It seems logical that patients who actually take part in the handover would rate the staffs’ information exchange higher, as they get an opportunity to see and hear how they communicate. However, a problem with this outcome measure is that it does not capture the patients’ actual in‐ volvement in the information exchange. Therefore, a higher score does not imply that the patients were taking on a more active role.

Being an inpatient on an oncological ward often includes long hours of waiting for information and is accompanied by uncertainty about the plans and activities related to one's care. Ideally, PCH can function as an opportunity to receive individualised information, provide one's own perspective and make joint plans for the next hours with nursing staff. In the present study, the patients reported improvements with the nurses’ information provision, indicating that PCH might have contributed to patients being better informed during their stay. The association between nurses’ information pro‐ vision and PCH is further strengthened by the ratings of doctors’ in‐ formation provision, which is not supposed to be affected by PCH. In the shift‐to‐shift report context, enhanced information provision is

often a core incentive for implementing bedside handovers. Despite this, previous quantitative evaluations have not been able to show improved patient‐reported outcomes on information provision (Kullberg et al., 2017; Sand‐Jecklin & Sherman, 2014; Scheidenhelm & Reitz, 2017). However, benefits regarding information issues have been reported in qualitative inquiries, such as patients gain‐ ing additional information about medications and the care plan for the upcoming shift (McMurray et al., 2011) or being reassured that the nurses conveyed accurate information about them to the other nurses (Lupieri et al., 2016). To our knowledge, our present study is the first to show improved information from nurses being reported by patients after the introduction of PCH.

Overall, the patients’ satisfaction with care resulted in mean scale scores comparable to other surveys using the same ques‐ tionnaire (Arraras et al., 2009; Bredart et al., 2005; Skret‐Magierlo, Ras, Barnas, & Skret, 2016). Apart from “Exchange of information between caregivers” and “Nurses’ information provision,” there were three exceptions where the participants in our study scored remarkably low, namely “Doctors’ interpersonal skills,” “Doctors’ availability” and “Comfort and cleanliness.” Regarding the doctors’ scales, we cannot with certainty explain what caused the difference between this and the first measurement. One speculation relates to the impact of the financial downsizing in the oncology department, resulting in further strains on physicians who were already working a tight schedule. Additionally, more patients in the present study were in a palliative stage and therefore may have needed more medical attention. The lowest score in the study was concerning comfort and cleanliness in the wards. This outcome is unlikely to be affected by PCH but is still worth highlighting as it stands out among the other scales. Cleanliness in hospitals is not only a question of maintaining good hygiene and preventing infections but is also connected to the wider patient experience of their hospital stay (Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) 2016). We do not have a plausible explanation for the low score and can only emphasise that the physical care environment should be a pri‐ ority for hospital management.

Another important dimension of the patients’ hospital experi‐ ence is the degree to which individualisation of care is supported and perceived. The results of the ICS‐A and the ICS‐B were obtained at a single measurement, and there were no previous data from the same wards to use for comparison. To add perspective to our rat‐ ings of individualised care among the participants in our study, we compared our results with data from Suhonen et al. (2016). In their survey, they described perceptions of individualised care among hospitalised cancer patients in four European countries. Of the 599 respondents, 141 who also reported the highest scores were re‐ cruited from a Swedish University Hospital. The data were collected five years prior to our study, and one inclusion criterion was >48 hr of hospitalisation, in contrast to our 3 days. The response rate was also lower (52% in the Swedish sample) compared with ours (75%). A difference in mean scores of ±0.5 was described as clinically im‐ portant (Suhonen et al., 2016). The participants in our study scored 0.54 units lower on the ICS‐B overall and on the subscales “Personal

TA B L E 2   Response rates, mean scores and 95% confidence intervals of the ICS‐A and ICS‐B and their subscales

n (%) Mean (95% CI)

Support of individuality (ICS‐A)

84 (93) 3.46 (3.19–3.73)

Clinical situation 84 (93) 3.71 (3.46–3.96)

Personal life situation 83 (92) 3.03 (2.74–3.32)

Decisional control 83 (92) 3.47 (3.21–3.73)

Perceptions of individuality (ICS‐B)

81 (90) 3.69 (3.42–3.96)

Clinical situation 81 (90) 3.85 (3.6–4.1)

Personal life situation 75 (83) 3.07 (2.77–3.37)

Decisional control 81 (90) 3.91 (3.66–4.16)

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life situation” and “Decisional control,” but no clinically important difference was observed in the ICS‐A. The results from the ICS in our study seem reasonable and fairly similar to those of surgical pa‐ tients reported in other studies (Suhonen, Efstathiou, et al., 2012; Suhonen, Välimäki, & Leiono‐Kilpi, 2005).

As in the present study, the subscales “Personal life situation” in both ICS‐A and ICS‐B consistently have lower scores than the other subscales in most surveys in which this questionnaire has been used. These subscales consider the patient's previous experiences of care, activities and daily habits outside of the hospital environment and the involvement of close ones in their care. It has been hypothesised that nurses in general are either not used to or not trained to ask patients about their personal lives outside of the current situation or to shape the care they provide in relation to previous personal experiences (Charalambous et al., 2012; Suhonen et al., 2004). In re‐ lation to PCH, one could expect the subscales regarding “Decisional control” and “Clinical situation” to be most relevant, as the hando‐ ver is focused on the patient's current status and cocreation of a plan for the next shift, rather than being based on previous experi‐ ences. Thus, the scores of the ICS in relation to PCH seem to be as expected.

In this study, the compared data (T1 and T2) were collected from different individuals; thus, a longitudinal approach where patients were followed over time could not be applied. This caused a lim‐ itation regarding the interpretation of the results. There might be factors other than the exposure of PCH among the participants that could explain the observed differences. At the same time, the groups seemed comparable in terms of age and sex, although there were more palliative patients taking part in the last measurement. The aim was to include 100 patients, but enrolment was closed after 90 pa‐ tients. There were several reasons for closing the study prematurely. One of the wards was temporarily closed down during the study pe‐ riod due to a nursing shortage. In addition, after seven months, both wards were permanently moved to a newly built hospital. As a result of the move, the hospital structure, staffing and organisation under‐ went major changes. Thus, the new wards could not be considered a comparable continuation of the previous ones, and the data collec‐ tion was therefore stopped. While we only managed to recruit 90 respondents, the response rate (75%) was good. The daily screening procedure reduced the risk of selection bias and promoted consec‐ utive sampling. However, patients were not approached on week‐ ends, evenings or nights so that those who were discharged during those hours were missed. We also did not gather background data on nonresponders, limiting the collected data just to responders. This was done primarily to honour the patients’ integrity. In our pre‐ vious study, no background variables (age, sex, treatment intention or educational level) were shown to have impacted the patient sat‐ isfaction scores (Kullberg et al., 2017). Suhonen et al. (2018) showed that cancer itself is the strongest determinant of how patients rate the quality of care, rather than, for example, educational level.

The use of validated instruments appropriate for the specific population is a strength of the study. The IN‐PATSAT32, ICS‐A and ICS‐B all refer to the entire duration of the hospital stay, during

which all types of experiences can form the basis for the ratings, while the nurse handover constitutes approximately five to ten minutes per day. To our knowledge, no specific instrument for pa‐ tients to evaluate the handover itself was available at the time of the study.

6  | CONCLUSION

In conclusion, the PCH model seemed to promote patients’ per‐ ceptions of information exchange between caregivers and the information provision from nurses. These positive results were observed 2 years after introducing PCH and thus seem sustain‐ able. Even though more long‐term randomised evaluations of bed‐ side handover models are needed, PCH can be recommended in the oncological inpatient setting and seems beneficial to crucial patient outcomes.

7  | RELE VANCE TO CLINIC AL PR AC TICE

This study can be of interest to any healthcare professional who is considering implementing PCH or a similar bedside handover model. The study provides a description of PCH that could be useful for clinicians. Our results further highlight the importance of persever‐ ance in the implementation process. For clinicians, this study adds to the body of evidence supporting bedside handover models and can be used as a motivator for its implementation. PCH is feasible in the inpatient oncology setting and has beneficial outcomes when viewed from a long‐term perspective.

CONFLIC T OF INTERE S T

The authors have no conflict of interest to declare.

ORCID

Anna Kullberg https://orcid.org/0000‐0001‐8626‐6034

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SUPPORTING INFORMATION

Additional supporting information may be found online in the Supporting Information section at the end of the article. 

How to cite this article: Kullberg A, Sharp L, Johansson H, Brandberg Y, Bergenmar M. Improved patient satisfaction 2 years after introducing person‐centred handover in an oncological inpatient care setting. J Clin Nurs. 2019;28:3262– 3270. https ://doi.org/10.1111/jocn.14903

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